About ALICE RAP: The project and results

ALICE RAP (Addiction and Lifestyles in Contemporary Europe - Reframing Addictions Project) was a five year European research project (2011-2016), co-financed by the European Commission that brought together around 200 scientists from more than 25 countries and 29 different disciplines. It aimed to strengthen scientific evidence to inform the public and political dialogue and to stimulate a broad and productive debate on current and alternative approaches to addictions.

ALICE RAP Science Findings

The ALICE RAP Science Findings, which give a simple account of the main results coming out of the different lines of researchundertaken in the project, have been grouped into 7 themes. Each Science Finding gives a summary of the results and links to further reading and the more detailed ALICE RAP deliverable reports.

How to use the AR Science Findings:

The AR Science Findings have been designed to lead you into the many ALICE RAP research studies and outputs.

Strictness and comprehensiveness of national addiction policies

Policy scaling tools, which translate national addiction policies into numbers and measure how strict and/or comprehensive they are, show that there are no unified and integrated addiction policies implemented throughout Europe.

Differences in the drug policy agenda among Nordic countries

Comparative analyses of historical and conceptual developments in Denmark, Finland, and Sweden show differences in the drug policy agenda and governance, despite fundamental similarities in these Nordic welfare states.

European addiction policies for the young

Although evidence supporting young people’s addictions policies is accumulating, the field is underdeveloped compared to adult orientated actions. Currently, for many areas of concern it is difficult to make strong evidence based recommendations to EU policy makers on effective policy actions for young people.

Scale of alcohol use disorders in EU

More than 11 million people aged 18-64 years are alcohol dependent in Europe (EU+ Iceland+ Norway+ Switzerland), whereas more than 22 million qualify for an alcohol use disorder (AUD; i.e. alcohol dependence or alcohol abuse/harmful use).

The cost of illicit drugs to the Portuguese criminal justice system

Portugal decriminalized personal use of all illicit drugs in 2001 and adopted a national strategy based on a strong public health focus. A 2010 quantitative estimate of the criminal justice sector costs for drug control in Portugal showed an expenditure of 73% for detention, 20% for the police sector and 7% for the justice sector. The high costs in the prison sector should be explored in greater depth, to understand whether or not they reflect the country’s new legislative framework and governance of addiction, or are due to other factors, such as investment in treatment services for prisoners.

Family members affected by addiction

Adult and child family members affected by their relatives’ heavy alcohol use, drug use, or gambling have a greatly increased risk of ill-health, but they continue to be neglected in research, policy and practice.

Addictions and social justice

Throughout modern history, addictions, in particular alcoholism, have been used to stigmatise “inferior” classes or people(s), including indigenous populations, and to discredit their social and national aspirations; currently this stigma still continues to exist, covering addicts as well as addiction treatment, and leads to serious health inequalities across social classes, peoples and countries.

C. What Determines Harm from Addictive Substances and Behaviours?

Evolutionary drivers

Understanding human evolutionary behaviour and the common mismatch between the way we run our lives in present times and the way our lives were run in the environment in which we evolved can provide better pointers as to what needs to be done to reduce the ill-health and premature death resulting from the use of alcohol and drugs.

Determinants of transitions in the development of harmful substance use and gambling

Determinants at the level of the social, economic and political environment are more important in the transition to risky substance use and gambling whilst determinants at the individual and sub-individual level of analysis are more dominant in the transition to harmful behaviours.

Determinants of moving out of harmful substance use and gambling

Limited research evidence exists on the determinants of transitions from high-risk to low-risk substance use and gambling that occur without clinical or psychotherapeutic intervention; however, evidence supports that a key driver of transitions from harmful to low-risk substance use or gambling is life changes in the user, for example getting a job, getting married and having children.

Implicit cognitions in addiction

Automatic biases towards alcohol drinking in adolescents are related to a genetic vulnerability; and online interventions which directly target such cognitive-motivational processes show promise as add-ons to treatment for clinical alcohol problems.

The World Health Organization expert committees and the concept of addiction

Expert committees of the WHO played a significant role in the development, dissemination and standardization of concepts and terminology around addiction in relation to drugs, alcohol and tobacco from the 1940s to the early 21st Century.

How the International Alcohol Conferences defined alcohol problems over time

International alcohol conferences from 1885 onwards began a process of internationalisation in understanding the concept of addiction, but this influence declined as national differences and tensions between European countries became sharper in the 1930s.

Stakeholders and addictions

The addictions field is characterised by tensions between groups, by entrenched relationships between some addiction-specific stakeholder groups and powerful political stakeholders, and by the dominance of some forms of evidence over other forms of knowledge. Science and scientists are mainly influential in policy terms only if their scientific findings ‘fit’ with the wider political and economic context.

How different countries' governing cultural constructions on addictions are formed

The media plays a crucial role in constructing popular narratives on addiction, which are also molded by country particularities such as the welfare regime, the most prominent addiction problem in the society, or the level of secularity.

Popular images of addictions

Cocaine, amphetamines and heroin are perceived by European citizens as the ‘addictions’ with the most severe consequences to society, whereas tobacco, despite being responsible for the largest share of premature deaths caused by addictive substances, is perceived as having one of the least severe impacts on society.

Depoliticization of Addiction

In recent decades, European countries have witnessed a process of withdrawing addictions from their political context in the media and public discourse. Social determinants of addictions were replaced by specific individual causes. Decreased authority of political and institutional actors made a room for individual experiences and experts representing mostly biomedical sciences.

E. Impact of market forces on addictive substances and behaviours

Channels of Corporate Influence

Corporate actors use a wider variety of channels to engage with policy makers. Not all of these are openly acknowledged. Policy makers’ are not always aware of these channels with potentially serious consequences for evidence based policy making.

In-lab exposure to alcohol advertisement causes physiological cue-reactivity and craving in alcohol dependent patients. However, the level of exposure to alcohol adverts in patients’ daily lives can not be demonstrated to affect the course of alcohol dependence.

Share of alcohol and tobacco consumed by those with problems

Drug dealers' business tactics

Imprisoned drug dealers reported that they aimed to sell mainly to regular customers and employed tactics to secure a stable customer base, including offering discounts, providing credit and even occasionally, offering ‘freebies’ or ‘extras’ to regular customers.

Drug dealers in Italy

Frequency of supply, price levels, quality and quantity of supplies, typical places and dealing techniques are different at various levels of the illicit drug supply chain and areas of Italy, outlining two main categories of dealers, each with typical characteristics: those who work as part of a criminal organization and those who work independently.

Where drug dealing money goes

The money Italian users spend on cocaine gets split very roughly into thirds: about one-third remains in the hands of the retailers who sell directly to users, one third going to the higher-level dealers within Italy, and one-third flowing out of the country and to international traffickers

Corporate Social Responsibility in addictive product sectors

Most Corporate Social Responsibility (CSR) activities of the addiction industry are not evaluated; those evaluations that do exist are not methodologically sound; and the very small numbers of relatively better-designed evaluations show negative impacts.

F. The New Governance of Addictive Substances and Behaviours

Foresighting the future of addiction governance

Contemplate future addiction governance in Europe. A focus on collective values, long-term planning and restitutive solutions may pave the way for novel policy measures conducive to reframing the challenges of addiction.

An ethical basis for addictions governance

Viewing policy and regulation from an ethical standpoint, the prohibition of certain drugs and criminalization of users does not fulfil any of the requirements in terms of protection of the rights of individuals to freedom of choice, reducing risks or promoting well-being of communities.

Bottom-up influence on future addiction governance

The EU is a moderation structure for the travel of policy ideas and transnational trends. In order to understand how this structure opens up for innovations in policy, it is important to understand how governance is influenced bottom-up by civil sector actors, expertise and local and regional authorities.

A European prevention agency

In Europe behavioural prevention interventions are currently implemented without a standard prior evaluation of their effectiveness, possibly leading to inefficient use of resources or even harmful effects.

Managing corporate influence

In the interests of public health, we need to rethink how we understand corporate power and manage it through policy structures, including adopting whole-government approaches, binding regulation, broadening the definition of ‘lobbying’ and tightening its regulation in relation to addictive industries in Europe and EU member states.

G. Networking and multi-disciplinary research

Interdisciplinary research for understanding addictions

Interdisciplinary research activity is challenging but crucial for developing a more nuanced and comprehensive understanding of and addressing the factors that influence the development of harmful substance use and gambling behaviours.

The value of stage-specific determinants for nuanced public health responses to addictions

Examining the determinants of transitions across a developmental trajectory of harmful behaviour can help with the identification of stage-specific (e.g. risky use, harmful use, cessation of use) determinants, which should result in earlier and more nuanced public health responses to the development of problem behaviourExamining the determinants of transitions across a developmental trajectory of harmful behaviour can help with the identification of stage-specific (e.g. risky use, harmful use, cessation of use) determinants, which should result in earlier and more nuanced public health responses to the development of problem behaviour.

Networking analysis as a management tool for complex research projects

Evaluation of large, trans-disciplinary research projects

Working in close collaboration, scholars from widely different backgrounds spanning the social sciences to the basic biomedical sciences succeed in providing policy makers with an integrated scientific framework for more effective substance use and addictions policy.